{clni_form}
	{*
	<table>
		<tr>
			<td><label>Test:</label></td> 
			<td>{input name="test_string" type="string"}</td>
		</tr>
		<tr>
			<td><label>Test:</label></td> 
			<td>{input name="test_string" type="date"}</td>
		</tr>
		<tr>
			<td></td>
			<td>{submit}</td>
		</tr>
	</table>
	*}
	
	<b>Progress Notes</b><br>

<table>
<tr>
<td>P:</td>
<td>{input type="string" name="p" size="5"}</td>

<td>R:</td> 
<td>{input type="string" name="r" size="5"}</td>
<td>BP:</td> 
<td>{input type="string" name="bp" size="5"}</td>
</tr>

<tr>
<td>HT:</td>
<td>{input type="string" name="bp" size="5"}</td>

<td>WT:</td> 
<td>{input type="string" name="bp" size="5"}</td>

<td>TEMP:</td>
<td>{input type="string" name="bp" size="5"}</td>

<td>LMP:</td>
<td>{input type="string" name="bp" size="5"}</td>
</tr>
</table>

<table>
<tr>
<td>Last Pap Smear:</td>
<td>{input name="last_pap_smear" type="date"}</td>

<td>Last Td. Booster:</td>
<td>{input name="last_td_booster" type="date"}</td>
</tr>
</table>
<table>
<tr>
<td>Allergies:<td>
<td>{input name="allegies" type="string" size="2"}</td>
<td>Last Mammogram:</td> 
<td>{input name="last_mammogram" type="date"}</td>
</tr>
</table>

	
	<p>{submit}</p>
</form>
